Spring 2020 Dusty's Food Pantry Form
Our mission is to provide a supplemental supply of non-perishable goods to currently enrolled students that face food insecurity in order to help them maintain their focus on academics.

Dusty's Food Pantry is an imperative part of our University's endless efforts to ensure students' success and is housed out of the Office of Student Conduct and Community Engagement (STC 226, 956-326-2265).

Dusty’s Food Pantry is committed to the confidentiality of each of our students that may be facing food insecurity. The following questions are solely to keep accurate data collection of the demographics of our students as well as the performance of the Food Pantry. The information provided below will be kept confidential and used only for statistics in our annual report.

NOTE: When picking up food items, please bring reusable bag. Plastic grocery bags will no longer be provided by Dusty's Food Pantry. Students will be given one reusable bag upon their first visit only.
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First Name
Last Name *
Gender *
Classification
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Are you classified as an international student? *
University ID Number *
Email *
Phone Number *
Is this your first time using Dusty's Food Pantry? *
Are you a first-generation college student? *
What is your Employment Status? *
What are your living arrangements/where do you live? *
Are you currently a student athlete at the university? *
What type of meal plan do you have? (If any) *
Are you currently on SNAP (Supplemental Nutrition Assistance Program) benefits? *
How did you hear about Dusty's Food Pantry? *
Liability Agreement
I understand that the items provided by Dusty’s Food Pantry have been donated by the community. With full knowledge of this, I, freely and voluntarily, do not hold the university (TAMIU), its offers, agents, employees, students, volunteers, and food suppliers, responsible for the quality, condition, or packaging of the food taken by Dusty’s Food Pantry. By providing my electronic signature, I acknowledge receipt of free food from Texas A&M International University and agree to the liability statement above.
Electronic Signature *
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